Innovative, Knowledge-based Programs Help the Chronically Ill Make Better Care Decisions with Their Doctors, Avoiding Hospital Admissions and ER Visits

CHICAGO, June 10 -- Harvard Medical School’s Department of Health Care Policy, as part of the Blue Cross and Blue Shield Association’s BlueWorks program, has recognized three programs designed to improve the quality of care delivered to chronically ill patients. The programs were developed and administered by Blue Companies in Minnesota, California and Illinois. While the programs take distinctly different approaches, all are focused on the same goal -- innovative, consumer-focused solutions that help support quality care decisions between patients and their doctors.

“All of these programs are based on a core premise: if we provide consumers with the information needed to support the care decisions they make with their physicians, patients with chronic illnesses can improve their health and their quality of life,” said Allan Korn, M.D., senior vice president and chief medical officer for the Blue Cross and Blue Shield Association (BCBSA). “These are good examples of how better knowledge leads to better more affordable care for consumers and their families.”

The treatment of chronic disease in the U.S. is one of the country’s most compelling and difficult health challenges. According to the Centers for Disease Control (CDC), the number of Americans with chronic illnesses will increase from 90 million to 157 million people by 2020. The CDC also reports that chronic diseases not only affect Americans health and quality of life, they are the most expensive medical conditions to treat, accounting for 75 percent of the nation’s total annual healthcare cost.

The programs recognized by Harvard researchers exemplify best practice models for the industry, improving the effectiveness and cost efficiency of the care provided to patients with chronic conditions.

For example, Blue Cross and Blue Shield of Minnesota developed the “BluePrint for Health Care Support Program” to deliver next- generation disease management by integrating care for numerous chronic conditions into one program. Preliminary results from the program indicate an 11 percent decrease in the overall rate of hospital admissions and an 18 percent decrease in ER visits.

This program goes beyond traditional disease management by coordinating the management of multiple conditions and creating a single point of contact for patients. The program also expands the number of conditions covered, ranging from diabetes and coronary artery disease to low back pain and osteoarthritis.

One of the major contributing factors in the maximizing the impact of “BluePrint for Health” is how the program is structured. According to Blue Cross and Blue Shield of Minnesota, by using an “opt-out” method, as opposed to traditional “opt-in” structure, the program engaged 95 percent of at-risk patients identified -- with a 90 percent satisfaction rate among participants.

“Targeting more conditions and personally engaging program participants early and often, provides a solid foundation for a healthier population and greater healthcare cost savings for years to come,” said Barbara McNeil, M.D., Chairperson of Harvard Medical School’s Department of Health Care Policy.

One thing that all of the programs have in common is that they make information sharing between consumers and physicians a top priority. According to a recent study by the RAND Corporation conducted on behalf of the Blue Cross and Blue Shield Association, more than 60 percent of Americans sought out healthcare information for themselves or a family member in the past year. RAND found that patients with serious chronic conditions were twice as likely to search for information as patients with minor chronic or acute illnesses. Sixty-five percent of patients with serious chronic conditions who searched for information discussed the information with their physicians.

“These programs selected by Harvard researchers provide tools that enrich the discussions and care decisions between patients and physicians,” said Dr. Korn.

Harvard researchers recognized Blue Cross of California’s “Congestive Heart Failure Health Improvement Program,” for its creative approach to reducing the number of avoidable hospitalizations each year by appointing registered nurses as true “Health Coaches” for members at risk for long-term congestive heart failure complications. The coaches work closely with patients to help them understand and overcome challenges to self-care so that they can improve their quality of life and avoid hospitalization.

The third program, “Motivating the Use of Flow Sheets for Diabetes and Coronary Artery Disease,” developed by Blue Cross and Blue Shield of Illinois, ensures that doctors have the information they need to deliver customized care to patients by encouraging the use of spreadsheets to track care and facilitate necessary treatments in a timely manner. The program leveraged its simplicity and the use of physician incentives to secure broad acceptance among healthcare providers.

“It is clear that knowledge-based programs that ensure patients and physicians have the information they need are highly successful in improving care quality for the patient, said Dr. McNeil. ”But the added benefit is that better quality care is more affordable care. Programs such as these are truly role models for the industry"

Programs developed by Blue Cross and Blue Shield companies are evaluated and recognized by Harvard Medical School’s Department of Health Care Policy are part of BCBSA’s “BlueWorks” program. BlueWorks programs are evaluated for importance to the healthcare system, potential applicability in other communities and level of innovation. For more information on BlueWorks, visit http://www.bcbs.com/blueworks.

The Blue Cross and Blue Shield Association is made up of 40 independent, locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 92 million -- nearly one-in-three -- Americans. For more information on the Blue Cross and Blue Shield Association and its Plans, please visit http://www.BCBS.com.

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Chris Hamrick

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Blue Cross and Blue Shield Association

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